TRADE
,A DO
Eopeii plication Mail In application Application # /Q
gress Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number 910-893-7525 Fax 910-893-2793
no www.harnett.org
Certification of Work Performed
By Own er/Contractor
Contractor Information
Kent Johnson
will complete the HVAC work on the project or
(Name) (Trade)
structure herein described. My state license number is 17164 All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances-and regulations.
Company Name: J&M Heating & Air, Inc.
Mailing Address: 724 Turlington Rd Dunn, NC 28334
Street Address: SAME
Business Phone: 910- 897-5501 Email Address: jm28334@aol.com
`Company name, address, & phone must match information on license.
I~KJob Information Phone•q l"M-H N5
Land Owner's Name: 11
Tenant/Building Owner(if different : ,1 Phone:
Construction or Site Address: 613 K -10wn A33ff
-PIN or Parcel # from GIS:
eafic Directions to Job from Lillin loni
T r► D l l lz~ly~ h t94, Fia i t~Qyt 11 tt rr~
_ i
U~ng_O NyAC V PpPts"~ A
Description of work to be done: Job Cost t •1 AN M14
Mechanical: New Unit With Ductwork New Unit Without Ductwork Gas Piping _
Electrical: 200 Amp _ <200 Amp _ Service Change _ Service-Reconnect _ Other_
Plumbing: Water/Sewer Tap _ Number of Baths _ Water Heater
/ Permit Cost
Permit Fee: $ 195.00 (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ (,0% . d(~5
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: Date:
DO NOT SEND CASH. INCO LETS APPLICATIONS WILL NOT BE PROCESSED.
10106
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